Steroidal aromatase inhibitors in elderly patients

The choice of treatment for elderly breast cancer patients needs particular care because the presence of physiological functional impairments can modi fy the drug bioavailability in an unpredictable manner. Hormonal treatment remains one of the choices and, although tamoxifen has proved to be effecti ve in any Setting, the use of selective aromatase inhibitors is arousing. D epending on their chemical structure, aromatase inhibitors are either stero idal (such as exemestane and formestane) or non-steroidal (such as letrozol e, vorozole and anastrozole). Formestane has been studied in elderly patien ts with breast cancer and has been found to induce an overall response rate of 51% (95% CI, 35-67%). The drug suppresses estradiol (E2) levels, and ch anges in other hormones (FSH, LH and SHBG) are observed, but with poor clin ical significance, thus confirming its selectivity and potency. Formestane has also been demonstrated to be as effective as tamoxifen. Exemestane and non-steroidal aromatase inhibitors appear to be very promising drugs. (C) 2 000 Elsevier Science Ireland Ltd. All rights reserved.